Tag: Anxiety

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Routine Online Psychological Therapy in an Insurance-Based Care Setting: Retrospective Service Evaluation of Real-World Outcomes

<strong>Background:</strong> Depression, anxiety, and stress-related difficulties represent a major global health burden. Online psychological therapy has emerged as a promising approach to increasing access to care, yet evidence from routine, real-world clinical settings, particularly for services delivered without standardized treatment protocols, remains limited. <strong>Objective:</strong> This study aimed to describe symptom change and patient-reported satisfaction associated with routine online psychological therapy delivered within an insurance-based care setting. <strong>Methods:</strong> A retrospective observational service evaluation was conducted using deidentified routine care data. Clients aged 15 years and older who initiated online psychological therapy and completed baseline and end-of-treatment assessments on all 3 outcome measures were included. Symptoms of depression, anxiety, and perceived stress were measured using the 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder (GAD-7), and 10-item Perceived Stress Scale (PSS-10), respectively. Changes in symptoms were examined using paired sample <i>t</i> tests, within-sample effect sizes (Cohen <i>d</i> and Cohen <i>d<sub>z</sub></i> with 95% CIs), and reliable change indices. Robustness was assessed with therapist-clustered mixed models and attrition sensitivity analyses. A ≥50% reduction in symptom scores was reported as a descriptive response criterion. Patient satisfaction was assessed with single-item ratings at the end-of-treatment assessment. <strong>Results:</strong> A total of 1221 clients were included. Clients completed a mean of 4.7 (SD 1.67) therapy sessions over an average treatment duration of 62.7 (SD 40.4) days. Significant reductions with large within-sample effect sizes were observed for depression (Cohen <i>d</i>=1.25, 95% CI 1.17-1.32), anxiety (Cohen <i>d</i>=1.49, 95% CI 1.41-1.57), and perceived stress (Cohen <i>d</i>=1.46, 95% CI 1.38-1.54). A ≥50% symptom reduction was observed in 60.7% (741/1220) of clients for depression, 67.5% (824/1221) for anxiety, and 30.8% (376/1221) for perceived stress. At the end-of-treatment assessment, 80.7% (985/1221) scored below the clinical cutoff for depression (PHQ-9&lt;10) and 79.2% (967/1221) for anxiety (GAD-7&lt;8). Reliable improvement was observed in 56% (688/1221) to 65% (794/1221) of clients, with deterioration below 2% on all measures. Mean patient-reported satisfaction scores ranged from 8.55 (SD 1.71) to 8.96 (SD 1.45) on a 10-point scale, and mean recommendation likelihood was 8.61 (SD 1.88). Therapist-level intraclass correlation coefficients were ≤0.029; effect sizes were 1.27-1.50 under inverse-probability weighting and 0.41-0.50 under zero-change imputation for baseline-screened clients without end-of-treatment assessments. <strong>Conclusions:</strong> Routine online psychological therapy delivered within an insurance-based care setting was associated with substantial pre-post symptom reductions, high proportions of clients meeting a descriptive ≥50% reduction criterion and showing reliable improvement, and high patient-reported satisfaction. Because the evaluation used an uncontrolled pre-post design restricted to clients with paired assessments, observed changes cannot be attributed causally to treatment. High satisfaction among responding clients is consistent with acceptability of the model to those clients; feasibility was not formally assessed, and inferences about comparative effectiveness require controlled designs.
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Perinatal Mental Health Detection and Prediction Using Mobile Sensing Data: Systematic Review

Background: Perinatal mental health disorders affect approximately 20% of pregnant and postpartum individuals, and are associated with substantial maternal and infant morbidity. Traditional assessment relies on infrequent, subjective self-reports. Mobile devices, including smartphones and wearables, offer opportunities for continuous and objective measurement, but evidence on their assessment utility in perinatal populations remains fragmented. Objective: This review aimed to examine the application of wearable devices and smartphones for detecting and predicting perinatal mental health outcomes, with emphasis on predictive performance, informative features, and methodological rigor. Methods: We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (PROSPERO CRD420251249218). Six databases (PubMed, Web of Science, Scopus, PsycINFO, IEEE Xplore, and ACM Digital Library) were searched initially in January 2026 and supplemented by an amended search in June 2026, with no publication date restrictions. Evidence was synthesized narratively, and the risk of bias was assessed using PROBAST+AI (Prediction Model Risk of Bias Assessment Tool With AI extension). Results: The initial and supplementary searches yielded 1952 unique records after deduplication, of which 10 studies met the inclusion criteria. The included studies covered postpartum depression, prenatal stress, discrete emotions during pregnancy (eg, happiness, anxiety, and sadness), and maternal loneliness. High discrimination metrics were reported for postpartum depression in individual studies, including a multiclass area under the curve of 0.85, a binary area under the curve of 0.871, and an -score of 0.9872. Heart rate variability, GPS-derived mobility, physical activity, and sleep features were most frequently reported as useful, and their interpretation requires perinatal-specific contextualization. Methodological quality was limited, with 80% (12/15) of PROBAST+AI assessment units rated as having high overall quality concern or risk of bias, mainly due to small samples, limited validation, inadequate handling of missing data, and potential overfitting in the analysis domain. Conclusions: Mobile sensing shows preliminary potential for perinatal mental health assessment, but current evidence does not yet support clinical screening or decision-making, and independent external validation in perinatal populations is currently lacking. Progress toward clinical utility requires broader mental health outcome coverage, larger longitudinal cohorts, standardized analytical and reporting practices, adoption of modeling approaches better suited to perinatal trajectories, independent external validation, and human-centered monitoring designs.
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Assessing the Need for Mental Health Support From Free-Text Responses: Development and Validation of Language-Based Assessments in Adults With Internalizing Symptoms

Background: Machine learning and natural language processing have demonstrated significant potential for mental health assessment: describing your mental health in your own words can offer a more ecologically valid approach than traditional rating scales. However, most models focus on specific diagnoses, conditions, or symptoms, which may prematurely assign labels and potentially reinforce stigma in the context of early-stage mental health screening. Objective: This study develops a language-based assessment model that assesses the need for mental health support based on probed natural language and validates it against best-estimate assessments from multiple experienced psychotherapists. Methods: We analyzed an enriched online sample (n=600 for development and n=212 for validation), in which about half reported experiencing internalizing symptoms (depression or anxiety). Participants described their mental health using open-ended responses regarding (1) mental health, (2) suicidal thoughts, (3) medical history, and (4) depression. The responses were converted into contextual word embeddings using a large language model and entered as predictors in a ridge regression using nested cross-validation. Two to three experienced psychotherapists assessed each participant’s need for mental health support on a scale from 1 (no support needed) to 5 (potential crisis). Their assessments were based on longitudinal clinical data (natural language, validated scales, clinical interview, sociodemographics, and clinical history) and were averaged into a best-estimate assessment for model validation. We used the Sequential Evaluation With Model Preregistration framework, which separates model development from validation in a held-out set to support robust estimations and generalizability. Results: The language-based assessments closely aligned with the best-estimate assessments (=0.82) and showed strong correlations with established clinical rating scales for depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder 7-Item Scale), stress (Perceived Stress Scale 10), and suicidality (Inventory of Depression and Anxiety Symptoms; =0.62-0.77). Language-based visualizations of topics and word embeddings showed that low need for support assessments was associated with mentioning well-being and good health, while high assessments were related to depression, anxiety, and suicidality. Conclusions: This study demonstrates that natural language responses analyzed through large language models and machine learning can be used to assess individuals’ need for mental health support in close alignment with best-estimate assessments from experienced psychotherapists. Using less than 5 minutes of respondent time, this approach offers a practical tool for early-stage mental health screening in both clinical and self-guided screening contexts.
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Non-motor correlates of anxiety in de novo Parkinson’s disease: a cross-sectional study with exploratory subgroup analyses

ObjectiveAnxiety is a prevalent early non-motor symptom of Parkinson’s disease (PD), but its clinical correlates remain poorly defined in de novo, drug-naïve patients. This retrospective cross-sectional study enrolled 284 medication-naïve de novo PD patients and 147 age- and sex-matched healthy controls to identify non-motor correlates of anxiety after adjustment for demographic and motor covariates, and explore potential subgroup heterogeneity.MethodsAnxiety was assessed with the Hamilton Anxiety Rating Scale; multivariate logistic regression and prespecified stratified analyses by age, sex, disease duration, Hoehn-Yahr stage and motor severity were performed.ResultsClinically significant anxiety was detected in 44.0% of PD patients versus 8.1% of controls (p < 0.001), with psychic anxiety as the dominant subtype. After multivariate adjustment, higher depressive symptom scores were positively associated with anxiety (OR = 1.386), whereas better sleep quality (OR = 0.965) and intact olfactory identification (OR = 0.815) were negatively associated with anxiety; motor severity showed no significant association after multivariable adjustment. Exploratory subgroup analyses revealed heterogeneous patterns of sleep and olfactory correlates across clinical strata. The three-factor predictive model yielded an overall classification accuracy of 84.81%.ConclusionThese findings indicate that non-motor abnormalities, rather than motor impairment, are associated with anxiety in early PD after adjustment for demographic and motor covariates. The distinct correlative patterns across subgroups provide preliminary clinical clues for the heterogeneous neurodegenerative processes underlying PD-related anxiety, and support routine screening of depressive, sleep and olfactory symptoms to facilitate anxiety risk stratification at initial diagnosis.
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Prevalence of positive screens for depression, anxiety, and PTSD symptoms among parents of infants admitted to a NICU: a pilot study

IntroductionParents of infants admitted to the Neonatal Intensive Care Unit (NICU) may experience substantial psychological distress. This study aimed to assess the prevalence of positive screens for depressive, anxiety, and post-traumatic stress disorder (PTSD) symptoms and to explore their associations with gender, education level, and parental age. The study also described the coping strategies reported by participants.MethodsThis cross-sectional pilot study assessed 82 parents of infants admitted to the NICU at Thumbay University Hospital, Ajman. Parents who were primary caregivers and provided consent were included. Data were collected from March to July 2025 using self-administered questionnaires; Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and PTSD Checklist for DSM-5 (PCL-5). They were then grouped based on whether they met the positive or negative screen criteria for the respective psychiatric symptoms.ResultsOut of the 82 parents who had participated, 22% screened positive for anxiety symptoms, 13.4% for depression symptoms, and 9.8% for PTSD symptoms. Female participants had a higher proportion of positive screen for depressive symptoms than male participants (20.5% vs. 4.8% in men, p = 0.043), and younger participants (≤30 years) had a higher proportion of positive screens for PTSD symptoms than those aged >30 years (17.5% vs. 2.4%; Fisher’s exact p = 0.027), although the small number of positive cases warrants cautious interpretation. No significant associations were found with education level. The most reported coping strategies were religious/spiritual (34.8%) and physical/behavioral (26.1%) methods.ConclusionA notable proportion of parents of infants admitted to the NICU in this UAE pilot cross-sectional study screened positive for symptoms of depression, anxiety, and PTSD, with female participants and younger participants showing higher proportions of positive screening for depressive and PTSD symptoms, respectively. These findings support consideration of mental health screening, promotion of a socially supportive environment, and culturally appropriate psychosocial support for parents of NICU-admitted infants.
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Case Report: Rapid resolution of psychogenic cough in an adolescent following bromazepam treatment

BackgroundSomatic cough syndrome, formerly termed psychogenic cough or habit cough, is an under-recognized cause of chronic cough in pediatric populations, characterized by repetitive, dry, and honking cough that is absent during sleep. Behavioral interventions are first-line treatment with high success rates of 80%–90%. However, when access to behavioral therapy is unavailable, alternative pharmacological interventions, particularly benzodiazepines, have received minimal investigation in this population.Case presentationI report a 13-year-old previously healthy male patient with abrupt-onset, near-continuous dry cough occurring every 2 seconds during waking hours. The cough had a distinctive honking quality and disappeared completely during sleep. The patient presented with severe impairment in function, including inability to eat for 3 days, multiple emergency presentations requiring intravenous hydration, and complete school absence. Medical evaluation, including physical examination, laboratory investigations, spirometry, and chest X-ray, was unremarkable. Empirical trials of inhaled bronchodilators and nasal corticosteroids yielded no improvement. Psychiatric assessment excluded psychotic features, depression, obsessive-compulsive disorder, and tic disorder but noted family stressors, including high expressed emotion and overprotective parenting behavior. Based on the sign of sleep-related cough cessation and exclusion of organic pathology, somatic cough syndrome was diagnosed. Given the severity of impairment and family circumstances precluding immediate behavioral therapy, bromazepam 3 mg orally was initiated. Within 24–36 hours, the cough resolved completely. At 3-month follow-up, the patient remained symptom-free without medication. He had returned to school and demonstrated normal eating patterns.ConclusionThis case demonstrates rapid and sustained resolution at 3-month follow-up of severe psychogenic cough following short-term bromazepam treatment in an adolescent. While behavioral therapy is still an evidence-based first-line treatment, this report suggests using benzodiazepines as a pharmacological intervention alternative when behavioral therapy is unavailable. The rapid response and sustained remission at 3-month follow-up are consistent with the hypothesis that benzodiazepines may interrupt the self-perpetuating cycle of anxiety and cough in somatic cough syndrome. Further research is needed for this case in pediatric populations to establish efficacy, safety, and optimal treatment duration.
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Implementing BEAM: A Scalable Digital Mental Health Program, for Families of Children Referred to Neurodevelopmental Services

Conditions: Depression and Anxiety Symptom; Anger; Parenting; Stress (Psychology); Parent Child Relationship; Child Development; Neurodevelopmental Conditions

Interventions: Behavioral: The Building Emotional Awareness and Mental Health (BEAM) Program

Sponsors: University of Manitoba; Children’s Hospital Research Institute of Manitoba; Kids Brain Health Network

Not yet recruiting
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Trajectories of Persistent Exposure to Self-Harm–Encouraging Websites and Subsequent Mental Health Outcomes in US Youth: Longitudinal Cohort Study

Background: Self-harm, including suicidal thoughts, self-injurious behavior, and disordered eating, is a major public health concern among adolescents and young adults. Youth increasingly encounter self-harm–related content online, including websites that explicitly encourage harmful behaviors. Although exposure to such content has been linked to poorer mental health, most research is cross-sectional and has not examined longitudinal exposure trajectories. Whether persistent exposure represents a distinct digital risk pattern remains unclear. Objective: This study examined longitudinal trajectories and correlates of exposure to self-harm–encouraging websites over 1 year and tested whether persistent exposure was associated with subsequent suicidal ideation, self-injury, and disordered eating. Methods: We analyzed data from 2197 US youth aged 13 to 22 years who completed waves 2 and 4 of Project Lift Up, a national longitudinal cohort study. Website exposure was categorized into 4 trajectories: none, desist (wave 2 only), new (wave 4 only), and persistent (both waves). Categories reflected reported exposure at the 2 assessment waves rather than the frequency or continuity of website use between assessments. Logistic regression models estimated associations between exposure trajectory and wave 4 suicidal ideation, self-injury, and disordered eating, restricting analyses to participants without the respective outcome at wave 2. Models were adjusted for demographics and wave 2 depression or anxiety symptoms and other mental health indicators. Results: Overall, 26.5% (583/2197) reported exposure to self-harm–encouraging websites at wave 2, and 18.5% (407/2197) reported persistent exposure. Privacy concerns, embarrassment, curiosity, and lack of offline support were associated with greater odds of persistence (adjusted odds ratios [aORs] 1.84‐3.23), whereas accidental exposure was associated with lower odds of persistence (aOR 0.28, 95% CI 0.19‐0.41). Compared with no exposure, persistent exposure was associated with higher odds of suicidal ideation (aOR 1.88, 95% CI 1.24‐2.86; =.003), self-injury (aOR 3.14, 95% CI 2.05‐4.80; <.001), and disordered eating (aOR 2.46, 95% CI 1.54‐3.93; <.001). Adjusted predicted probabilities showed a graded pattern, with persistent exposure associated with the highest predicted probabilities (suicidal ideation: 33.4% vs 21.3%; self-injury: 25.7% vs 10.2%; disordered eating: 11.7% vs 5.3%). New exposure was associated with increased odds of self-injury (aOR 2.32, 95% CI 1.30‐4.15; =.004) but was not significantly associated with suicidal ideation or disordered eating. The desist trajectory was not significantly associated with outcomes. Conclusions: Persistent exposure to self-harm–encouraging websites may represent a distinct digital risk pattern associated with higher subsequent odds of suicidal ideation, self-injury, and disordered eating. Assessing patterns of repeated website exposure and youths’ motivations for seeking this content—not merely whether exposure occurred—may improve the identification of youth at heightened risk and inform digital prevention and clinical intervention strategies.
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Effectiveness and Usability of Digital Slow Breathing and Detached Mindfulness Interventions in Late Adolescents: Mixed Methods Study

Background: Many adolescents experience elevated stress and anxiety; yet, access to effective psychological support is limited. Brief digital mental health interventions, such as slow breathing (SB) and detached mindfulness (DM), offer a potentially scalable approach to promoting emotion regulation in daily life. Objective: This study aimed to investigate whether 1 week of daily practice with a SB or DM intervention reduced stress, anxiety, and negative metacognitive beliefs in youth, and explored participants’ experiences to inform the development of accessible, youth-tailored digital interventions. Methods: A mixed method approach was used, including quantitative and qualitative data. A total of 147 university students between 16 and 19 years old were randomly allocated to the DM (n=49), SB (n=49), or passive control group (n=49). Participants who were allocated to DM or SB practiced the intervention for 1 week. Stress, anxiety, and negative metacognitive beliefs were assessed at pre- and postintervention using self-report questionnaires. The quantitative data were analyzed with linear mixed-effects models, and we explored daily changes in intervention effect. After posttest, participants were invited to focus groups to evaluate their experience with the interventions (n=37). The qualitative data were analyzed with a content analysis. Results: Our results showed that a week-long DM intervention significantly reduced stress compared with the control condition. No other differences emerged for the main outcomes on pre- and postmeasurements. However, in the SB group, higher perceived usability was associated with greater reductions in stress. Qualitative findings showed that both interventions were viewed as calming, easy to use, and acceptable, while also highlighting challenges such as maintaining motivation and integrating the exercises into daily routines. Conclusions: This study provides early formative evidence that brief digital interventions such as SB and DM are feasible and usable, with preliminary indication that DM intervention may support short-term stress reduction. Future research should focus on enhancing motivation and sustained engagement to maximize the effectiveness of digital mental health tools for late adolescents. Trial Registration: OSF Registries osf.io/vu56y; https://osf.io/vu56y/overview
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Neural mechanisms of uncertain decision-making in anxious adolescents: an EEG study based on the balloon analogue risk task

BackgroundAdolescence is marked by heightened vulnerability to anxiety which can impair decision-making under uncertainty. The underlying neural oscillatory network-level mechanisms in anxious adolescents require further elucidation.MethodsWe recruited 40 adolescents (20 adolescents with clinically diagnosed anxiety disorders, 20 matched controls). Participants performed a gain/loss version of the Balloon Analogue Risk Task (BART) during EEG recording. Behavioral data, time-frequency EEG power in beta (13–30 Hz) and theta (4–7 Hz) bands, and phase-based functional connectivity were analyzed.ResultsAnxious adolescents exhibited significant behavioral avoidance, reflected in fewer pump attempts and lower BART scores compared to controls. EEG analysis revealed elevated beta-band power during gain decisions and enhanced beta-band occipito-temporal connectivity in the anxious group. In loss contexts, anxious adolescents showed increased theta-band parieto-temporal connectivity.ConclusionsAdolescent anxiety is associated with a generalized avoidance pattern during uncertain decision-making, characterized by distinct neural dynamics. Beta-band changes in gain contexts may reflect heightened vigilance, while theta-band connectivity in loss contexts may indicate amplified threat monitoring. These neural signatures may represent candidate neurophysiological signatures of anxiety-related alterations in decision-making under uncertainty, warranting further validation in longitudinal and predictive studies.